ICU机械通气患者撤机后呼吸肌训练的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.01.005

摘要/Abstract

摘要：

目的提炼并总结ICU机械通气患者撤机后呼吸肌训练的最佳证据，为临床机械通气患者撤机后的呼吸肌训练提供循证依据。方法系统检索国内外相关指南网站、专业协会网站以及PubMed、Web of Science、Embase、CINAHL、中国知网、维普数据库、万方数据库等关于机械通气患者撤机后呼吸肌训练相关的文献，包括指南、临床决策、证据总结、专家共识、系统评价及随机对照试验，检索时限为建库至2023年7月30日。2名研究者独立进行文献质量评价和资料提取。结果共纳入13篇文献，其中指南2篇、临床决策2篇、系统评价5篇、专家共识4篇。总结了包括训练团队、训练评估、训练方式、训练频次、训练安全性、效果评价及健康教育7个方面的24条最佳证据。结论该研究总结了ICU机械通气患者撤机后呼吸肌训练的最佳证据，为临床护理人员规范进行撤机后患者的呼吸肌训练提供依据，建议护理人员结合临床实际情况选择性应用最佳证据。

关键词: 重症监护病房, 机械通气, 撤机, 呼吸肌训练, 循证护理学

Abstract:

Objective The best evidence of respiratory muscle training for patients with mechanical ventilation in ICU after machine withdrawal was extracted and summarized to provide evidence-based evidence for respiratory muscle training for patients with mechanical ventilation after machine withdrawal. Methods We searched relevant guideline networks and association websites，as well as PubMed，Web of Science，Embase，CINAHL，CNKI，VIP，Wanfang and other databases to collect relevant guidelines，clinical decisions，evidence summaries，expert consensuses，systematic reviews and randomized controlled studies，and the search time limit is from the establishment of the databases to July 30，2023. There were 2 researchers who independently evaluated the literature quality and extracted data. Results A total of 13 articles were included，including 2 guidelines，2 clinical decisions，5 systematic reviews and 4 expert consensuses. There were 24 pieces of evidence being summarized in 7 categories，including training team，training evaluation，training methods，training frequency，training safety，training effect evaluation and health education. Conclusion This study summarizes the best evidence for respiratory muscle training in patients with mechanical ventilation after withdrawal，which can provide references for medical staffs to conduct respiratory muscle training for patients after withdrawal. It is recommended that medical staff should consider the clinical situation when applying the evidence，and selectively apply the best evidence.

Key words: Intensive Care Units, Mechanical Ventilation, Mechine Withdrawal, Respiratory Muscle Training, Evidence-Based Nursing

尹佳宁, 管晓敏, 贾登帅, 徐玲, 陈兰. ICU机械通气患者撤机后呼吸肌训练的最佳证据总结[J]. 中华护理杂志, 2024, 59(1): 33-41.

YIN Jianing, GUAN Xiaomin, JIA Dengshuai, XU Ling, CHEN Lan. Summary of best evidence of respiratory muscle training in patients with mechanical ventilation after withdrawal[J]. Chinese Journal of Nursing, 2024, 59(1): 33-41.

图/表 7

图1 PubMed检索策略

Figure 1 Literature search strategy of PubMed

图2 文献筛选流程图

Figure 2 Flow chart of literature

表1 纳入文献的基本情况(n=13)

Table 1 Characteristics of included studies(n=13)

表2 指南的方法学质量评价结果(n=2)

Table 2 Quality evaluation of guidelines(n=2)

表3 专家共识的方法学质量评价结果(n=4)

Table 3 Quality evaluation of consensuses(n=4)

表4 系统评价的方法学质量评价结果(n=5)

Table 4 Quality evaluation of systematic reviews(n=5)

表5 ICU机械通气患者撤机后呼吸肌训练的最佳证据总结

Table 5 Summary of best evidence of respiratory muscle training in patients with mechanical ventilation after withdrawal

参考文献 31

[1]	Ma JG, Zhu B, Jiang L, et al. Gender-and age-based differences in outcomes of mechanically ventilated ICU patients:a Chinese multicentre retrospective study[J]. BMC Anesthesiol, 2022, 22(1):18. DOI PMID
[2]	徐蕊, 何瑞波, 汤静. 高强度吸气肌抗阻训练对支气管扩张患者运动能力及生活质量的影响[J]. 中华物理医学与康复杂志, 2022, 44(1):52-56.
	Xu R, He RB, Tang J. High-intensity inspiratory muscle resistance training can improve the exercise capacity and life quality of persons with bronchiectasis[J]. Chin J Phys Med Rehabil, 2022, 44(1):52-56.
[3]	Vorona S, Sabatini U, Al-Maqbali S, et al. Inspiratory muscle rehabilitation in critically ill adults. A systematic review and meta-analysis[J]. Ann Am Thorac Soc, 2018, 15(6):735-744. DOI PMID
[4]	姚丽, 杨琳, 杨丽平, 等. 机械通气患者吸气肌训练效果的Meta分析[J]. 中华护理杂志, 2020, 55(1):141-147. DOI URL
	Yao L, Yang L, Yang LP, et al. Inspiratory muscle training in patients with mechanical ventilation:a Meta-analysis[J]. Chin J Nurs, 2020, 55(1):141-147.
[5]	Celli BR, Stoller JK, Hatipoglu U. Respiratory muscle training and resting in COPD[EB/OL]. (2023-06-15)[2023-07-30]. https://www.uptodate.cn/contents/respiratory-muscle-training-and-resting-in-copd.
[6]	中国医师协会呼吸医师分会, 中华医学会呼吸病学分会, 中国康复医学会呼吸康复专业委员会, 等. 中国慢性呼吸道疾病呼吸康复管理指南(2021年)[J]. 中华健康管理学杂志, 2021, 15(6):521-538.
	Chinese Association of Chest Physicians,Chinese Thoracic Society, Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, et al. Guidelines for respiratory rehabilitation management of chronic respiratory diseases in China[J]. Chin J Health Manag, 2021, 15(6):521-538.
[7]	马姚静, 王鑫鑫, 余群飞, 等. 重度特发性脊柱侧凸患者肺康复的最佳证据总结[J]. 中华护理杂志, 2023, 58(14):1758-1765. DOI URL
	Ma YJ, Wang XX, Yu QF, et al. Evidence summary of pulmonary rehabilitation in patients with severe idiopathic scoliosis[J]. Chin J Nurs, 2023, 58(14):1758-1765. DOI URL
[8]	Sandoval MLM, Casas QIC, Wilches LEC, et al. Efficacy of res-piratory muscle training in weaning of mechanical ventilation in patients with mechanical ventilation for 48 hours or more:a randomized controlled clinical trial[J]. Med Intensiva Engl Ed, 2019, 43(2):79-89.
[9]	王婷, 侯冉, 常杲杲, 等. 头颈部肿瘤放疗患者吞咽功能训练的最佳证据总结[J]. 中华护理杂志, 2023, 58(14):1712-1718. DOI URL
	Wang T, Hou R, Chang GG, et al. Summary of the best evidence for swallowing function training in patients with head and neck cancer undergoing radiotherapy[J]. Chin J Nurs, 2023, 58(14):1712-1718 DOI URL
[10]	刘婷, 谭小雪, 徐娜飞, 等. 妊娠期糖尿病孕妇运动方案的最佳证据总结[J]. 中华护理杂志, 2020, 55(10):1514-1519. DOI URL
	Liu T, Tan XX, Xu NF, et al. Evidence summary of exercise regimens for patients with gestational diabetes mellitus[J]. Chin J Nurs, 2020, 55(10):1514-1519. DOI URL
[11]	郭俊晨, 龚有文, 戴云云, 等. 生命末期成人住院患者护理评估的最佳证据总结[J]. 中华护理杂志, 2023, 58(13):1571-1578. DOI URL
	Guo JC, Gong YW, Dai YY, et al. Summary of best evidence for comprehensive nursing assessment of adults hospitalised at the end of life[J]. Chin J Nurs, 2023, 58(13):1571-1578. DOI URL
[12]	武亮, 郭琪, 胡菱, 等. 中国呼吸重症康复治疗技术专家共识[J]. 中国老年保健医学, 2018, 16(5):3-11.
	Wu L, Guo Q, Hu L, et al. Consensus of technical experts on respiratory rehabilitation of severe diseases in China[J]. Chin J Geriatr Care, 2018, 16(5):3-11.
[13]	Berry AB, Bennett J, Chaseling W, et al. Physical activity and movement:a guideline for critically ill adults[EB/OL]. (2017-07-26)[2023-07-30]. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0005/239783/ACI-Physical-activity-movement-guideline-critically-ill-adults.pdf.
[14]	Mukpradab S, Mitchell M, Marshall AP. An interprofessional team approach to early mobilisation of critically ill adults:an integrative review[J]. Int J Nurs Stud, 2022, 129:104210. DOI URL
[15]	庞永丽, 方蘅英, 罗媛容, 等. 肝硬化患者营养评估与管理的最佳证据总结[J]. 中华护理杂志, 2020, 55(9):1420-1425. DOI URL
	Pang YL, Fang HY, Luo YR, et al. Best evidence summary of nutritional assessment and management in patients with liver cirrhosis[J]. Chin J Nurs, 2020, 55(9):1420-1425. DOI URL
[16]	Celli BR, Stoller JK. Pulmonary rehabilitation[EB/OL]. (2023-07-10)[2023-07-30]. https://www.uptodate.cn/contents/pulmonary-rehabilitation.
[17]	王秋雁, 边仁秀, 戎军, 等. 浙江省重症康复专家共识[J]. 浙江医学, 2017, 39(24):2191-2196,2209.
	Wang QY, Bian RX, Rong J, et al. Consensus of experts on severe rehabilitation in Zhejiang province[J]. Zhejiang Med J, 2017, 39(24):2191-2196,2209.
[18]	宫玉翠, 陈洁雅, 李平东, 等. 慢性呼吸疾病肺康复护理专家共识[J]. 中华护理杂志, 2020, 55(5):709-710. DOI URL
	Gong YC, Chen JY, Li PD, et al. Expert consensus on pulmonary rehabilitation nursing of chronic respiratory diseases[J]. Chin J Nurs, 2020, 55(5):709-710. DOI URL
[19]	孟祥艳, 樊毫军. ARDS患者肺康复训练专家共识[J]. 中国急救复苏与灾害医学杂志, 2022, 17(4):421-426.
	Meng XY, Fan HJ. Expert consensus on lung rehabilitation training for ARDS patients[J]. China J Emerg Resusc Disaster Med, 2022, 17(4):421-426.
[20]	Lang JK, Paykel MS, Haines KJ, et al. Clinical practice guidelines for early mobilization in the ICU:a systematic review[J]. Crit Care Med, 2020, 48(11):e1121-e1128. DOI URL
[21]	丁楠楠, 姚丽, 张志刚, 等. ICU机械通气患者早期目标导向康复锻炼安全标准的系统评价[J]. 中华危重病急救医学, 2019, 31(1):91-97.
	Ding NN, Yao L, Zhang ZG, et al. Safety criteria for early goal-oriented rehabilitation exercise in patients undergoing mechanical ventilation in intensive care unit:a systematic review[J]. Chin Crit Care Med, 2019, 31(1):91-97.
[22]	Linke CA, Chapman LB, Berger LJ, et al. Early mobilization in the ICU:a collaborative,integrated approach[J]. Crit Care Explor, 2020, 2(4):e0090. DOI URL
[23]	Young B, Moyer M, Pino W, et al. Safety and feasibility of early mobilization in patients with subarachnoid hemorrhage and ex-ternal ventricular drain[J]. Neurocrit Care, 2019, 31(1):88-96. DOI
[24]	Harris CL, Shahid S. Physical therapy-driven quality improvement to promote early mobility in the intensive care unit[J]. Bayl Univ Med Cent Proc, 2014, 27(3):203-207.
[25]	杨玉洁, 刘桂英, 李若祎, 等. ICU机械通气患者吸气肌训练的研究进展[J]. 中国护理管理, 2020, 20(9):1436-1440.
	Yang YJ, Liu GY, Li RY, et al. Research progress of inspira-tory muscle training for intensive care patients with mechanical ventilation[J]. Chin Nurs Manag, 2020, 20(9):1436-1440.
[26]	杨雪凝, 李雪儿, 王松, 等. 慢性阻塞性肺疾病患者呼吸肌训练的最佳证据总结[J]. 中华护理杂志, 2022, 57(1):49-55. DOI URL
	Yang XN, Li XE, Wang S, et al. Summary of best evidence of respiratory muscle training in patients with chronic obstructive pulmonary disease[J]. Chin J Nurs, 2022, 57(1):49-55. DOI URL
[27]	岳明叶, 王慧华, 胡玉婷, 等. 吸气肌训练促进心脏手术病人肺康复的研究进展[J]. 护理研究, 2022, 36(5):858-863.
	Yue MY, Wang HH, Hu YT, et al. Research progress on in-spiratory muscle training on promoting pulmonary rehabilita-tion for patients undergoing cardiac surgery[J]. Chin Nurs Res, 2022, 36(5):858-863.
[28]	Souza L, Guimarães B, Lugon J. Use of a new isokinetic device oriented by software for inspiratory muscle training in prolonged weaning[C]// Acute Critical Care,European Respiratory Society, 2017:40.
[29]	Thompson PD, Arena R, Riebe D, et al. ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription,ninth edition[J]. Curr Sports Med Rep, 2013, 12(4):215-217. DOI URL
[30]	Keles MN, Elbasan B, Apaydin U, et al. Effects of inspiratory muscle training in children with cerebral palsy:a randomized controlled trial[J]. Braz J Phys Ther, 2018, 22(6):493-501. DOI URL
[31]	Nepomuceno BRV Jr, Barreto MS, Almeida NC, et al. Safety and efficacy of inspiratory muscle training for preventing adverse outcomes in patients at risk of prolonged hospitalisation[J]. Trials, 2017, 18(1):626. DOI PMID